Pathological anatomies such as tumors and lesions can be treated with an invasive procedure, such as surgery, which can be harmful and full of risks for the patient. A non-invasive method to treat a pathological anatomy or other target is external beam radiation therapy. A “target” as discussed herein may be an anatomical feature(s) of a patient such as a pathological anatomy (e.g., tumor, lesion, vascular malformation, nerve disorder, etc.) or normal anatomy and may include one or more non-anatomical reference structures. In one type of external beam radiation therapy, an external radiation source is used to direct a sequence of x-ray beams at a tumor site from multiple angles, with the patient positioned so the tumor is at the center of rotation (isocenter) of the beam. As the angle of the radiation source changes, every beam passes through the tumor site, but passes through a different area of healthy tissue on its way to the tumor. As a result, the cumulative radiation dose at the tumor is high and the average radiation dose to healthy tissue is low.
The term “radiotherapy” refers to a procedure in which radiation is applied to a target region for therapeutic, rather than necrotic, purposes. The amount of radiation utilized in radiotherapy treatment sessions is typically about an order of magnitude smaller, as compared to the amount used in a radiosurgery session. Radiotherapy is typically characterized by a low dose per treatment (e.g., 100-200 centiGray (cGy)), short treatment times (e.g., 10 to 30 minutes per treatment) and hyperfractionation (e.g., 30 to 45 days of treatment). For convenience, the term “radiation treatment” is used herein to include radiosurgery and/or radiotherapy unless otherwise noted.
Conventional radiation treatment can be divided into at least two distinct phases: treatment planning and treatment delivery. A treatment planning system may be employed to develop a treatment plan to deliver a requisite dose to a target region, while minimizing exposure to healthy tissue and avoiding sensitive critical structures. A treatment delivery system may be employed to deliver the radiation treatment according to the treatment plan. Treatment plans specify quantities such as the directions and intensities of the applied radiation beams, and the durations of the beam exposure. A treatment plan may be generated from input parameters such as beam positions, beam orientations, beam shapes, beam intensities, and radiation dose distributions (which are typically deemed appropriate by the radiologist in order to achieve a particular clinical goal). Sophisticated treatment plans may be developed using advanced modeling techniques and optimization algorithms.
Two kinds of treatment planning procedures are conventionally known: forward planning and inverse planning. In forward treatment planning, a medical physicist determines the radiation dose of a chosen beam and then calculates how much radiation will be absorbed by the tumor, critical structures (i.e., vital organs), and other healthy tissue. There is no independent control of the dose levels to the tumor and other structures for a given number of beams, because the radiation absorption in a volume of tissue is determined by the properties of the tissue and the distance of each point in the volume to the origin of the beam and the beam axis. The treatment planning system then calculates the resulting dose distribution and the medical physicist may iteratively adjust the values of the treatment parameters during treatment planning until an adequate dose distribution is achieved.
In contrast, the medical physicist may employ inverse planning to specify the minimum dose to the tumor and the maximum dose to other healthy tissues independently, and the treatment planning system then selects the direction, distance, and total number and intensity of the beams in order to achieve the specified dose conditions. Given a desired dose distribution specified and input by the user (e.g., the minimum and maximum doses), the inverse planning module selects and optimizes dose weights and/or beam directions, i.e. select an optimum set of beams that results in such a distribution. Inverse planning may have the advantage of being able to produce better plans, when used by less sophisticated users.
Developing an appropriate treatment plan is especially challenging for tumors that are larger, have irregular shapes, or are close to a sensitive or critical structure. Some conventional radiation systems attempt to optimize the treatment plan prior to delivery. One such radiation system is the TomoTherapy Hi-Art System® available from TomoTherapy, Inc., of Madison, Wis. The Hi-Art System facilitates optimization of the treatment plan by calculating a planned dose into a phantom and then measuring a dose delivered into the phantom. Although such a system may facilitate optimization of the treatment plan during the treatment planning stage, it does not optimize radiation treatment based on the radiation actually delivered to the target region during the treatment delivery stage.
Whether forward planning or inverse planning is used, conventional treatment plans assume specific treatment conditions. However, the actual treatment conditions during treatment delivery are typically different from the treatment planning assumptions. Such differences are not reflected in the treatment plan because they are unknown at the time of treatment planning and may result in an error between the planned radiation dose and the actual radiation dose. Conventional radiation treatment systems allow such deviations as acceptable tolerance errors and do not determine or generate any kind of record of the error. Furthermore, conventional radiation treatment systems do not allow the treatment delivery to be modified based on the difference between the planned dose and the actual dose delivered.